Cartilage Volume Research Articles

Effect of hematoma-induced changes in auricular hardness, thickness and volume on the propagation components of cartilage conduction hearing: assessments by hearing threshold and ear-canal sound pressure

Abstract Cartilage conduction (CC) is a method of perceiving sounds via biological tissues by presenting a transducer to the auricular cartilage. Unlike conventional bone conduction perceived via bony sections of the skull, conduction through light auricular cartilage requires a weak force, resulting in lesser pain. CC is useful in individuals with auricular deformities such as auricular hematoma, in whom, ordinary earphones are unsuitable. However, hematoma-induced changes in the hardness, thickness, and volume of auricular cartilage might affect CC perception. This study investigated the effects of these factors on perception and sound propagation in CC by measuring hearing threshold and ear-canal sound pressure (ECSP) in individuals with normal-ear-morphology and auricular hematoma. The results showed that increased hardness, thickness and estimated hematoma volume were associated with low ECSP and high hearing thresholds at 250-1000 Hz suggesting that increased auricular mass and greater transducer-to-eardrum distance reduced vibration and/or air-conduction efficiency, potentially impacting CC perception.

Degeneration of the cartilage quality is correlated with a higher intramuscular fat infiltration of the vastus medialis in older adults with pre-to-mild knee osteoarthritis.

To quantitatively verify whether degeneration in the quality of the medial femoral cartilage is correlated with muscle volume loss and intramuscular adipose tissue (IntraMAT) infiltration in quadriceps using magnetic resonance imaging (MRI). Of the 66 older adult participants ≥60years old (74.5±6.9 years), 29 were female. All participants were patients with pre-to-mild knee osteoarthritis. Muscle volume and IntraMAT infiltration of the four individual muscles, the rectus femoris (RF), vastus medialis (VM), vastus intermedius, and vastus lateralis were assessed, using proton density-weighted and 2-point Dixon MR images. Based on the MRI T2 mapping, the T2 relaxation times of the weight-bearing surface of the medial femoral cartilage were calculated. Simple linear regression analyses were performed, evaluating the correlations between the T2 relaxation time of the medial femoral cartilage and quadriceps muscle volume and IntraMAT. Multiple linear regression analysis using a stepwise method was performed, determining which indicators of the four individual muscles correlated with cartilage quality degeneration. Simple linear regression analyses revealed that a longer T2 relaxation time of the medial femoral cartilage was positively correlated with IntraMAT infiltration of the entire quadriceps muscle, RF, and VM, however not with the quadriceps muscle volume. Multiple linear regression analysis revealed that VM IntraMAT was particularly correlated with the extension of T2 relaxation time of the medial femoral cartilage. In older adults with pre-to-mild knee osteoarthritis, IntraMAT infiltration of the quadriceps muscles, particularly of the VM was correlated with degeneration in the quality of the medial femoral cartilage.

In vivo impact on rabbit subchondral bone of viscosupplementation with a hyaluronic acid antioxidant conjugate

ObjectiveThis study aimed to assess the effects of an antioxidant-conjugated Hyaluronic Acid (HA), specifically HA-4-aminoresorcinol (HA4AR), on articular cartilage and subchondral bone in osteoarthritis (OA). We conducted a comparative analysis between HA4AR and a commercially available high molecular weight HA formulation in a rabbit model of OA.Materials and methodsEighteen rabbits underwent unilateral anterior cruciate ligament transection (ACLT) and were divided into three groups of six: Saline-group, HA-group, and HA4AR-group, based on the type of intra-articular injection received. Additionally, eight non-operated contralateral knees served as reference points (Contralateral-group). Six weeks post-surgery, iodine-enhanced micro-computed tomography imaging was used to evaluate articular cartilage volume and thickness, and to assess subchondral bone microarchitecture and mineral density.ResultsCartilage thickness in both the HA and HA4AR groups was comparable to that of the Contralateral group. Notably, there was a significant reduction in subchondral bone plate tissue mineral density in the HA-group when compared to both the HA4AR and Saline groups (p < 0.05). However, no significant differences in trabecular subchondral bone microarchitectural parameters and mineral densities were observed between the HA4AR-group and the Saline-group. When compared to the Contralateral, Saline, and HA4AR groups, the HA-group exhibited a marked decrease in subchondral bone plate tissue mineral density (p < 0.05). Additionally, a significant reduction in trabecular bone volume fraction was noted in the HA-group compared to the Contralateral-group (p < 0.05).ConclusionsThe HA-4AR hydrogel demonstrated significant preservation of subchondral bone plate tissue mineral density compared to HA alone, while other bone microarchitectural parameters remained largely unchanged. These findings indicate that HA-4AR may provide enhanced osteoprotective benefits in the treatment of osteoarthritis.

A Standardized Boswellia serrata Extract Improves Knee Joint Function and Cartilage Morphology in Human Volunteers with Mild to Moderate Osteoarthritis in a Randomized Placebo-Controlled Study

Background and objective Boswellia serrata Roxb. ex Colebr. (Family: Burseraceae; Genus: Boswellia) gum resin (Salai guggul) has profound therapeutic value in Ayurvedic and Unani medicines in alleviating several chronic inflammatory illnesses, including arthritis, asthma, skin and blood diseases, fever, etc. SN13108F (Aflapin®) is a proprietary, standardized Boswellia serrata gum resin extract. This 180-day randomized, placebo-controlled clinical study aimed to evaluate cartilage morphology using magnetic resonance imaging (MRI), pain and joint function and long-term safety in the SN13108F-supplemented volunteers with knee osteoarthritis (KOA). Materials and methods Eighty adult male and female subjects with the Kellgren-Lawrence grade II - III KOA were supplemented with SN13108F (100 mg/day) or a matched placebo for 180 consecutive days. Results SN13108F reduced (p < 0.001; vs. baseline and placebo) Western Ontario and McMaster Universities Osteoarthritis Index, Visual Analogue Scale, Lequesne’s Functional Index scores, improved six-minute walk test, and stair climb test. Post-trial MRI assessments of the tibiofemoral joints revealed that the cartilage volume, thickness, and joint space width were increased (p < 0.001; vs. placebo), and levels of high-sensitivity C-reactive protein, matrix metalloproteinase-3, Fibulin-3, type II collagen degradation peptide in serum, and cross-linked C-terminal telopeptide of type II collagen in urine were significantly reduced (p < 0.001; vs. baseline and placebo) in the SN13108F-supplemented subjects. Hematology, complete serum biochemistry, urine analysis, and the participants’ vital signs did not alter between the groups. Conclusion SN13108F supplementation is safe, and it mitigates joint pain and improves musculoskeletal function and cartilage morphology in KOA.

Sacroiliac joint auricular surface morphology modulates its mechanical environment.

The sacroiliac joint (SIJ) exhibits significant variation in auricular surface morphology. This variation influences the mechanics of the SIJ, a central node for transmitting mechanical energy from upper body to lower limbs and vice versa. The impact of the auricular surface morphology on stress and deformation in the SIJ remains poorly understood to date. Computed tomography scans obtained from 281 individuals were included to extract the geometry of the pelvic ring. Then, the auricular surface area, SIJ cartilage thickness, and total SIJ cartilage volume were identified. Based on these reconstructions, 281 finite element models were created to simulate SIJ mechanical loading. It was found that SIJ cartilage thickness only weakly depended on age or laterality, while being strongly sex sensitive. Auricular surface area and SIJ cartilage volume depended weakly and non-linearly on age, peaking around menopause in females, but without significant laterality effect. Larger SIJs, characterized by greater auricular area and cartilage volume, exhibited reduced stress and deformation under loading. These findings highlight the significant role of SIJ morphology in its biomechanical response, suggesting a potential link between morphological variations and the risk of SIJ dysfunction. Understanding this relationship could improve diagnosis and targeted treatment strategies for SIJ-related conditions.

Correction of Microtia with Constricted Ear Features Using Helix Costal Cartilage Scaffold and Postauricular Flap Advancement.

Microtia with constricted ear features represents a challenging congenital deformity characterized by the variable shape and large volume of the remnant cartilage and skin involved. This study aims to evaluate the efficacy and safety of a method using helix costal cartilage scaffold and postauricular flap advancement for the correction. This retrospective study analyzed the clinical and postoperative data of 121 patients diagnosed with microtia and constricted ear features, treated at our institution between January 2020 and January 2023. All patients underwent helix reconstruction using the eighth or ninth costal cartilage combined with postauricular flap advancement. Outcomes were assessed based on the incidence of postoperative complications and auricular aesthetic scores. The aesthetic evaluation of the reshaped auricle was based on a four-point Likert scale (i.e. 1 = poor, 2 = fair, 3 = good, 4 = excellent). The postoperative follow-up period ranged from 12 months to 3 years (mean 18.5 months). All patients achieved successful helix expansion, with reconstructed ears showing improved symmetry and shape comparable to the contralateral normal ears. The average aesthetic score was 3.4 out of 4. Complications included suture exposure in 8.3% of cases and cartilage protrusion in 4.1%, both managed without significant issues. There were no instances of skin necrosis, costal cartilage exposure, or infection. The combination of helix costal cartilage scaffold and postauricular advancing flap offers a reliable and effective method for correcting microtia with constricted ear features, providing satisfactory aesthetic outcomes with minimal complications.

Safety and efficacy of placental mesenchymal stromal cells-derived extracellular vesicles in knee osteoarthritis: a randomized, triple-blind, placebo-controlled clinical trial

BackgroundKnee osteoarthritis causes pain and disability in many people worldwide, for which no definitive treatment has yet been proposed. In this study, we investigated the safety and efficacy of placental mesenchymal stromal cells-derived extracellular vesicles in patients with knee osteoarthritis.MethodsThis triple-blind, randomized clinical trial included patients suffering from bilateral knee osteoarthritis with grade 2 or 3. The knees of each patient were randomized to intervention and control. For the intervention knee, 5 cc of placental mesenchymal stromal cells-derived extracellular vesicles were injected, and for the control knee, 5 cc of normal saline was injected. The patients’ symptoms were evaluated before the intervention and 2 and 6 months after the intervention using VAS, WOMAC questionnaire, and Lequesne index. MRI was performed before the intervention and 6 months after the intervention to evaluate retropatellar and tibiofemoral cartilage volume, medial and lateral meniscal disintegrity, ACL injury, and effusion-synovitis.Results62 knees (31 patients) were enrolled in this study. There were 31 knees as intervention and 31 knees as control. Finally, the data of 58 knees (29 patients) were analyzed, including 28 women and 1 man. The mean age of the patients was 55.38 ± 6.07 years. No statistically significant difference was detected between the two groups in clinical outcomes (including VAS, WOMAC, and Lequesne scores) before treatment and 2 and 6 months after treatment. Also, no statistically significant difference was detected between the two groups in MRI findings before treatment and 6 months after treatment. No systemic complications or severe local reactions occurred in the patients.ConclusionA single intra-articular injection of placental mesenchymal stromal cells-derived extracellular vesicles (5 cc, 7 × 109 particles/cc) is safe, but does not improve clinical symptoms or MRI findings in knee osteoarthritis beyond placebo. The protocol of this study was approved on 11 May 2022 with registration number IRCT20210423051054N1.

Treatment with a superoxide dismutase mimetic for joint preservation during 35 and 75 days in orbit aboard the international space station, and after 120 days recovery on Earth

Reduced weight-bearing during spaceflight has been associated with musculoskeletal degradation that risks astronaut health and performance in transit and upon reaching deep space destinations. Previous rodent experiments aboard the international space station (ISS) have identified that the spaceflight-induced molecular arthritic phenotype was characterized with an increase in oxidative stress. This study evaluated if treatment with a superoxide dismutase (SOD) mimetic on orbit could prevent spaceflight-induced damage to the knee and hip articular cartilage, and the menisci in rodents. Cartilage and meniscal degradation in mice were measured via microCT, histology, and transcriptomics after: (1) ∼ 35 days on the ISS, (2) ∼ 35 days on the ISS followed by 120 days weight-bearing readaptation on Earth or (3) ∼ 75 days on the ISS. The study had a limited sample size, so both significant effects and generalized patterns are reported. After 35 days aboard the ISS, cartilage volume at the tibial-femoral cartilage-cartilage contact point decreased, meniscal volume decreased concurrent with an increase in pro-osteoarthritic signaling in the joint soft tissue. Similarly, a decrease in cortical and trabecular bone volume of the tibia was observed. Treatment with the SOD mimetic preserved the trabecular bone, articular cartilage and the menisci after 35 days aboard the ISS, but had limited efficacy retaining that recovery after 120 days of weight bearing, and after 75 days on orbit. Antioxidants including BuOE may serve as a potential countermeasure option to protect musculoskeletal health during spaceflight missions, and continued use may be necessary upon reaching a destination.

External Focus of Attention Reduces Cartilage Load During Drop Landings.

The aim of the present study was to examine the effects of attentional focus instructions on acute changes in the transverse relaxation time (T2) of the femorotibial cartilage and in cartilage volume during repeated drop-jump landings. Ten healthy females (Mage = 20.4 ± 0.8 years) performed a drop landing task from a 50 cm high box over the course of 3 days (50 repetitions each day) across three attentional focus conditions: external focus (EF: focus on landing as soft as possible), internal focus (IF: focus on bending your knees when you land), and control (CON: no-focus instruction), which was counterbalanced across focus conditions. T2 mapping and the volume of femorotibial cartilage were determined from magnetic resonance imaging scans at 1.5 T for the dominant knee before and after completing the drop landings in each attentional focus condition per day. Results indicated a smaller change in cartilage T2 relaxation time and volumetry in the central load-bearing lateral cartilage under the EF, compared to IF and CON. Moreover, the change in T2 and cartilage volume was greater for lateral tibial cartilage as compared to femoral cartilage and was independent of attentional focus instructions. No significant acute quantitative changes were observed in the medial compartment. The peak vertical ground reaction force was found to be the lowest under the EF, compared to IF and CON. These findings suggest that external focus of attention may reduce cartilage load, potentially aiding in the control or management of cartilage injuries during landing in female athletes.

An accelerated PETALUTE MRI sequence for in vivo quantification of sodium content in human articular cartilage at 3T

ObjectiveIn this work, we evaluate the sodium magnetic resonance imaging (MRI) capabilities of a three-dimensional (3D) dual-echo ultrashort echo time (UTE) sequence with a novel rosette petal trajectory (PETALUTE), in comparison to the 3D density-adapted (DA) radial spokes UTE sequence in human articular cartilage in the knee.Materials and methodsWe scanned five healthy subjects using a 3D dual-echo PETALUTE acquisition and two comparable implementations of 3D DA-radial spokes acquisitions, one matching the number of k-space projections (Radial – Matched Spokes) and the other matching the total number of samples (Radial – Matched Samples) acquired in k-space.ResultsThe PETALUTE acquisition enabled equivalent sodium quantification in articular cartilage volumes of interest (168.8 ± 29.9 mM, mean ± standard deviation) to those derived from the 3D radial acquisitions (171.62 ± 28.7 mM and 149.8 ± 22.2 mM, respectively). We achieved a 41% shorter scan time of 2:06 for 3D PETALUTE, compared to 3:36 for 3D radial acquisitions. We also evaluated the feasibility of further acceleration of the PETALUTE sequence through retrospective compressed sensing with 2 × and 4 × acceleration of the first echo and showed structural similarity of 0.89 ± 0.03 and 0.87 ± 0.03 when compared to non-retrospectively accelerated reconstruction.ConclusionWe demonstrate improved scan time with equivalent performance using a 3D dual-echo PETALUTE sequence compared to the 3D DA-radial sequence for sodium MRI of articular cartilage.

Critical evaluation of the current role of SYSADOA in the management of osteoarthritis (literature review)

Background. Osteoarthritis is a common chronic disease characterized by progressive degradation of all joint components and inflammation. The priority issue in the management of OA is sear­ching for drugs that simultaneously relieve symptoms, modify the course of the disease, and are safe for use. Symptoma­tic slow-ac­ting drugs (SYSADOA) are of considerable interest due to their potential to slow cartilage degeneration and potential osteoarthritis di­sease mo­difying effect. The purpose of the study was to ana­lyze current literature data on several types of SYSADOA, their biological role, mecha­nisms of effect on joints, effectiveness and safetye. ­Materials and methods. An analytical review of literature data was conducted using the ana­lysis of scientific databases PubMed, Web of Science, Scopus, Google Scholar for the period 2005–2024, the search was conducted using the keywords “osteoarthritis”, “SYSADOA”, “DMOAD”, “effectiveness”, “safety”. Results. Glucosamine salts (GA) and chondroitin sulfate (CS) are the most stu­died slow-acting drugs and have positive biological effects on joint tissues. Prescription salts of GA and CS have effect of pain relieve and joint function improvement as separate agents and also potentiate the effect in combination. Studies revealed limiting of cartilage volume loss and joint space narrowing – a potential DMOAD effect of these drugs. GA salts and CS drugs are safe, as they have no difference in the frequency of side effects compared to placebo. The quality of drugs largely depends on the type of raw materials and technological production process, which are not standardized now. Conclusions. The role of SYSADOA in the treatment of OA has not been definitively determined, and studies on the effectiveness of drugs such as SYSADOA and the study of their DMOAD effect are still ongoing. Further stu­dies should focus on the use of pharmacological class SYSADOA that have been properly purified and quality strictly supervised.

Phosphotungstic acid-enhanced micro-computed tomography and RNA sequencing provide a new perspective on temporomandibular joint arthritis induced by complete Freund's adjuvant and collagen-induced arthritis in rat models

Background/PurposeTemporomandibular joint (TMJ) arthritis causes inflammation and degradation of the mandibular condylar cartilage and subchondral bone. Complete Freund's adjuvant (CFA) and collagen-induced arthritis (CIA) are models for studying TMJ arthritis. While micro-computed tomography (micro-CT) is crucial for three-dimensional (3D) bone analysis, it has limitations in imaging nonmineralized tissues. Phosphotungstic acid (PTA) enhances soft tissue contrast. However, research on the 3D imaging of mandibular condylar cartilage and the molecular mechanisms of CFA- and CIA-induced arthritis remains unclear. This study aimed to investigate the bone and PTA-stained cartilage in the mandibular condyle using 3D reconstruction and explore the characteristics of enriched gene ontology terms underlying CFA- and CIA-induced TMJ arthritis in rat models. Materials and methodsRat mandibular condyles were collected from control, CFA, and CIA groups. Live micro-CT created 3D bone structures, and PTA-enhanced micro-CT constructed 3D mandibular condylar cartilage. Gene ontology enrichment analysis identified enriched gene ontology terms from differentially expressed genes through RNA sequencing. ResultsMajor deformities in cartilage volume and bone morphology were observed in the arthritis-induced groups. The CIA group exhibited significant correlations between cartilage volume and bone parameters changes. Gene ontology enrichment analysis indicated fewer terms with upregulated differentially expressed genes related to inflammation and immune response in the CIA group than in the CFA group. ConclusionThis study reveals distinct responses between CFA- and CIA-induced TMJ arthritis models. The CIA group exhibited strong correlations between cartilage volume and bone parameter changes and had less pronounced inflammation and immune response than the CFA group.

New concept of orthosis treatment for knee osteoarthritis: Clinical and radiological outcomes.

Given the increasing numbers of young patients with knee osteoarthritis there is a need for treatments that can postpone a joint prosthesis (total knee replacement). As an alternative to the effective yet invasive knee joint distraction procedure, a knee orthosis was developed aiming to unload the affected knee and improving synovial fluid flow. The aim of this study was to examine the effectiveness of using a load-reducing orthosis for two months on functioning, pain, and disease progression (e.g. amount of damaged cartilage) in patients with symptomatic osteoarthritis of the knee for at least one year. This is an interventional single-center pilot study. Ten patients with symptomatic osteoarthritis of one knee (5males/5 females; median age 57; age range 42-59) used a custom-made orthosis for 60 days during daily life activities that involved knee loading (e.g. standing, walking, but not during stair climbing). Cycling was not allowed. Clinical outcomes were assessed up to 24 months after intervention at 6 timepoints using patient reported-outcome measures Western Ontario and McMaster Universities Osteoarthritis (WOMAC) range 0-100; Visual Analogue Scale (VAS), range 0-100 for pain. Minimum joint space width (mJSW) was assessed using knee images digital analysis (KIDA) and articular cartilage volume with magnetic resonance imaging (MRI) using custom software at baseline and at 12 and 24 months follow-up. Clinically beneficial effects were found for functioning (WOMAC improvement compared to baseline ranged between 18 points at 3 months follow-up and 31 points at 12 months follow-up, with only the 24-months follow-up (improvement of 27 points) not reaching statistical significance (p< 0.05)) and for pain (VAS improvement compared to baseline at follow-up time points ranged between 41-56 points; all p< 0.05). No improvements in mJSW- or MRI-derived parameters were found. This study demonstrates that use of a custom-made knee-unloading orthosis for 60 days can result in improved functional ability and decrease in pain in relatively young patients with knee osteoarthritis. No effect on disease progression could be evidenced.

Safety and efficacy of an allogeneic adipose-derived mesenchymal stem cell preparation in the treatment of knee osteoarthritis: A Phase I/IIa randomised controlled trial

ObjectivesTo assess the safety and efficacy of an allogeneic adipose-derived mesenchymal stem cell preparation (MAG200) in the treatment of knee osteoarthritis over 12 months. DesignA single-centre, double-blind, ascending dose, randomised controlled trial. 40 participants with moderate knee osteoarthritis were randomised to receive a single intra-articular injection of MAG200 (dose cohorts:10, 20, 50, 100 ​× ​106 ​cells) or placebo. Primary objectives were safety and efficacy according to a compound responder analysis of minimal clinically important difference in pain (numerical pain rating scale [NPRS]) and function (Knee Injury and Osteoarthritis Outcome Score - Function in Daily Living subscale [KOOSADL]) at month 12. Secondary efficacy outcomes included changes from baseline in patient reported outcome measures and evaluation of disease-modification using quantitative MRI. ResultsTreatment was well tolerated with no treatment-related serious adverse events. MAG200 cohorts reported a greater proportion of responders than placebo and demonstrated clinical and statistically significant improvement in pain and clinically relevant improvement in all KOOS subscales. MAG200 demonstrated a reproducible treatment effect over placebo, which was clinically relevant for pain in the 10 ​× ​106 dose cohort (mean difference NPRS:-2.25[95%CI:-4.47,-0.03, p ​= ​0.0468]) and for function in the 20 ​× ​106 and 100 ​× ​106 dose cohorts (mean difference KOOSADL:10.12[95%CI:-1.51,21.76, p ​= ​0.0863] and 10.81[95%CI:-1.42,23.04, p ​= ​0.0810] respectively). A trend in disease-modification was observed with improvement in total knee cartilage volume in MAG200 10, 20, and 100 ​× ​106 dose cohorts, with progression of osteoarthritis in placebo, though this was not statistically significant. No clear dose response was observed. ConclusionThis early-phase study provides supportive safety and efficacy evidence to progress MAG200 to later-stage trial development. Trial registrationACTRN12617001095358/ACTRN12621000622808.

Cross-species transcriptomics identifies obesity associated genes between human and mouse studies

BackgroundFundamentally defined by an imbalance in energy consumption and energy expenditure, obesity is a significant risk factor of several musculoskeletal conditions including osteoarthritis (OA). High-fat diets and sedentary lifestyle leads to increased adiposity resulting in systemic inflammation due to the endocrine properties of adipose tissue producing inflammatory cytokines and adipokines. We previously showed serum levels of specific adipokines are associated with biomarkers of bone remodelling and cartilage volume loss in knee OA patients. Whilst more recently we find the metabolic consequence of obesity drives the enrichment of pro-inflammatory fibroblast subsets within joint synovial tissues in obese individuals compared to those of BMI defined ‘health weight’. As such this present study identifies obesity-associated genes in OA joint tissues which are conserved across species and conditions.MethodsThe study utilised 6 publicly available bulk and single-cell transcriptomic datasets from human and mice studies downloaded from Gene Expression Omnibus (GEO). Machine learning models were employed to model and statistically test datasets for conserved gene expression profiles. Identified genes were validated in OA tissues from obese and healthy weight individuals using quantitative PCR method (N = 38). Obese and healthy-weight patients were categorised by BMI > 30 and BMI between 18 and 24.9 respectively. Informed consent was obtained from all study participants who were scheduled to undergo elective arthroplasty.ResultsPrincipal component analysis (PCA) was used to investigate the variations between classes of mouse and human data which confirmed variation between obese and healthy populations. Differential gene expression analysis filtered on adjusted p-values of p < 0.05, identified differentially expressed genes (DEGs) in mouse and human datasets. DEGs were analysed further using area under curve (AUC) which identified 12 genes. Pathway enrichment analysis suggests these genes were involved in the biosynthesis and elongation of fatty acids and the transport, oxidation, and catabolic processing of lipids. qPCR validation found the majority of genes showed a tendency to be upregulated in joint tissues from obese participants. Three validated genes, IGFBP2 (p = 0.0363), DOK6 (0.0451) and CASP1 (0.0412) were found to be significantly different in obese joint tissues compared to lean-weight joint tissues.ConclusionsThe present study has employed machine learning models across several published obesity datasets to identify obesity-associated genes which are validated in joint tissues from OA. These results suggest obesity-associated genes are conserved across conditions and may be fundamental in accelerating disease in obese individuals. Whilst further validations and additional conditions remain to be tested in this model, identifying obesity-associated genes in this way may serve as a global aid for patient stratification giving rise to the potential of targeted therapeutic interventions in such patient subpopulations.

Association between medial meniscal extrusion and knee structural progression in adults with symptomatic knee osteoarthritis — a prospective cohort study

ObjectiveTo examine the association between medial meniscal extrusion and structural progression in adults with symptomatic knee osteoarthritis (OA).MethodsThis prospective cohort study examined 176 participants with symptomatic knee OA recruited into a randomised controlled trial. The participants underwent magnetic resonance imaging (MRI) of the study knee at baseline and approximately 2 years later. Meniscal extrusion, tibial cartilage volume, and tibiofemoral bone marrow lesions (BMLs) were measured from MRI using validated methods.ResultsParticipants with medial meniscal extrusion ≥ 3 mm had a higher prevalence of lateral tibiofemoral BMLs at baseline (OR = 2.21, 95% CI 1.06–4.61, p = 0.035), and those with medial meniscal extrusion 2–3 mm had a higher likelihood of lateral BML worsening over 2 years (OR = 3.76, 95% CI 1.35–10.52, p = 0.011), compared with those with medial meniscal extrusion < 2 mm. Participants with stable medial meniscal extrusion had a lower likelihood of lateral BML worsening compared with those with regression of medial meniscal extrusion over 2 years (OR = 0.20, 95% CI 0.07–0.56, p = 0.002). There were no associations between medial meniscal extrusion and tibial cartilage volume or medial tibiofemoral BMLs.ConclusionsOur study showed associations between medial meniscal extrusion and baseline prevalence and worsening over 2 years of lateral tibiofemoral BMLs in people with symptomatic knee OA. Although the reasons for the lack of associations in the medial compartment are not clear, our results suggest a role of medial meniscal extrusion in predicting structural progression in lateral knee OA and that meniscal extrusion might be a potential target in the management of knee OA.

Versatility and Outcomes of 'Mumbai Technique' of Stacked Cartilage Grafts in Indian Rhinoplasty.

Background Augmentation rhinoplasty requires graft with substantial volume. In cases where patient is reluctant to use costal cartilage, this can be done using septum and conchal cartilage graft. Using the technique of "stacked cartilage graft" an assembly is made using septum and conchal cartilage for nasal augmentation and contour defects. Although multilayered grafts have been described before, we propose an elaborate and effective method named after our city, Mumbai, to shape these grafts and highlight economical use of conchal and septal cartilage to overcome its limited volume. It also describes its clinical and aesthetic outcome of this technique in Indian patients. Materials and Methods A retrospective study from 2005 to 2020 was done in our institute. Data was collected from medical and hospital records. Preoperative and postoperative photographs were obtained for preoperative planning and outcome analysis. Rhinoplasty Outcome Evaluation score was used for outcome analysis. Minimum follow-up was 1 year in our study. Results A total of 210 patients were included in our study. In all cases, the stacked cartilage graft technique produced a natural appearing dorsum. Complications of cartilage such as resorption, extrusion, and warping were minimum. All the patients were satisfied with their results. Conclusion Although the limited volume of conchal cartilage is criticized, in reality it can be used effectively for larger requirement with "economy of use" using our technique. The curvatures and convolutions of conchal cartilage can be effectively neutralized by using this technique to obtain a smooth surface. However, this technique requires incorporation of every bit of cartilage and meticulous stacking of the pieces to get the desired shape. Thus, the stacked cartilage grafts have excellent versatility and produce natural and long-lasting results and minimal complications.

Cartilage Oligomeric Matrix Protein in Osteoarthritis and Obesity-Do New Considerations Emerge?

The diagnosis of osteoarthritis (OA) is based on radiological changes that are delayed, along with clinical symptoms. Early and very early diagnosis at the stage of molecular pathology may eventually offer an opportunity for early therapeutic intervention that may retard and prevent future damage. Cartilage oligomeric matrix protein (COMP) is a non-collagenous extracellular matrix protein that promotes the secretion and aggregation of collagen and contributes to the stability of the extracellular matrix. There are contradictory literature data and currently, the parameter is used only for scientific purposes and its significance is not well-determined. The serum level of COMP in patients with metabolic type OA of the knee has not been evaluated. The aim of the study was to analyze serum COMP levels in metabolic knee OA and controls with different BMI. Our results showed that the mean COMP values were significantly higher in the control group (1518.69 ± 232.76 ng/mL) compared to the knee OA patients (1294.58 ± 360.77 ng/mL) (p = 0.0012). This may be related to the smaller cartilage volume in OA patients. Additionally, COMP levels negatively correlated with disease duration (p = 0.04). The COMP level in knee OA with BMI below 30 kg/m2 (n = 61, 1304.50 ± 350.60 ng/mL) was higher compared to cases with BMI ≥ 30 kg/m2 (n = 76, 1286.63 ± 370.86 ng/mL), but the difference was not significant (p = 0.68). Whether this finding is related to specific features in the evolution of the metabolic type of knee OA remains to be determined. Interestingly, comparison of COMP levels in the controls with different BMI revealed significantly higher values in overweight and obese individuals (1618.36 ± 203.76 ng/mL in controls with BMI ≥ 25 kg/m2, n = 18, 1406.61 ± 216.41 ng/mL, n = 16; p = 0.0092). Whether this finding is associated with increased expression of COMP in the adipose tissue or with more intensive cartilage metabolism in relation to higher biomechanical overload in obese patients, considering the earlier development of metabolic type knee OA as an isolated finding, remains to be determined.

Effects of high-intensity interval exercise training on knee health and articular cartilage volume in patients with obesity: A comparative study between bicycle and treadmill groups

ObjectiveIt's a comparative study between bicycle and treadmill groups to observe the effects of high-intensity interval exercise training on knee health and articular cartilage volume in patients with obesity, thus to provide a scientific basis for the healthy exercise methods to lose weight. Methods60 patients with simple obesity were randomly divided into two groups of 30: the bicycle group and the treadmill group. Both groups received high-intensity interval exercise training, power bicycle training and moving treadmill training (MTT) were accepted respectively. Both groups received consecutive treatment for 12 weeks, five times a week, and every single time lasted for 30 min. Before and after treatment, the body mass index (BMI), the knee's articular cartilage volume was measured with magnetic resonance imaging (MRI),the pain of knee was assessed with visual analogue scale (VAS). Before and after each training session, the local skin temperature of the knee was measured with an electronic thermometer. ResultsAfter 12 weeks of treatment, the BMI was both decreased, the VAS and the local skin temperature of knee was increased significantly, the knee's articular cartilage volume in the treadmill group was reduced significantly, while the above indicators in the bicycle group did not change significantly, and the difference between the two groups was statistically significant (p < 0.001). ConclusionPower bicycle training can avoid a decrease in the volume of knee joint cartilage, while MTT can easily lead to a decrease in the volume of knee joint cartilage, an increase in local skin temperature and pain of knee joint.

Relationship Between 2 Years of Muscle Strength Decrease and Volume Loss of Menisci and Cartilage According to Knee Pain in Mild and Moderate Knee Osteoarthritis.

The aim of the study is to explore the relationship between 2-yr changes in muscle strength and cartilage according to knee pain in mild and moderate knee osteoarthritis. Two hundred seventy-nine participants were retrospectively obtained from the Osteoarthritis Initiative. Western Ontario McMaster University and Knee Injury and Osteoarthritis Outcome Score were used to assess pain and function. Five muscles strength (maximum extensor and flexor, normalized maximum extensor and flexor, and extensor/flexor ratio) were measured from isometric strength test. Menisci and cartilage volumes were measured from magnetic resonance imaging to assess 2 yr of osteoarthritis progression. Mild and moderate knee osteoarthritis progression was characterized by patellofemoral cartilage loss and meniscal degeneration. For WOMAC pain >2 participants, decrease in extensor strength and normalized extensor strength were positively correlated with medial meniscus volume loss (r = 0.261, P = 0.021; r = 0.232, P = 0.041, respectively). The extensor/flexor ratio changes were positively associated with Western Ontario McMaster University function changes (r = 0.291, P = 0.013) over 2 yrs. The study observed a positive correlation between quadriceps strength decrease and medial meniscus degeneration in mild and moderate knee osteoarthritis patients with Western Ontario McMaster University pain >2. These findings suggested quadriceps-hamstrings balance possibly plays a protective role in knee function for participants with weaker quadriceps and severe pain. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. Upon completion of this article, the reader should be able to: 1): Determine the effect of knee extensor muscle strength changes on the medial and lateral meniscus, tibia, and medial and lateral femoral cartilage over 2 yrs in mild to moderate knee osteoarthritis patients; 2): Describe the correlation of knee extensor strength with the medial and lateral meniscus, tibia, and medial and lateral femoral cartilage at different WOMAC-pain levels; and 3): Discuss the relationship between changes in muscle strength and changes in meniscus and cartilage volume and WOMAC pain scores over 2 yrs in mild to moderate knee osteoarthritis patients. Advanced. The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.